Historically, the development of healthcare real estate has been a bifurcated process by which real estate developers buy either land to build new facilities or buildings to redevelop. Then the end-user, whether a medical practice, ambulatory surgical center operator, or healthcare system, purchases or leases the facility.

Usually there is limited, if any, collaboration between the developer and the end user on the design of the facility. However, the successful bonding of real estate development and medical facility design requires a comprehensive focus on the strategic priorities and needs of physicians, providers, healthcare systems, and the patients and families they serve.

Aspect Health Inc., a Connecticut based real estate owner/developer/operator with an extensive background in hotels, multitenant office buildings, and medical office buildings, is working to address this disconnect. Its goal: to deliver advanced healthcare facilities using the latest research and technologies to deliver a better overall experience, not only for patients but also the providers and health systems that serve them. Christopher R. Smith, CEO of Aspect Health, defines this concept as “healthcare hospitality.”

Once Aspect Health identified the development design/disconnect and recognized the value inherent in hospitality-driven healthcare, it launched the concept of research-informed development.

This two-pronged effort focuses on conducting in-depth research on the needs of the various stakeholders in the delivery and consumption of healthcare services and translating the results into facility design and development. It bridges research, business strategy, design, construction, and the practice of healthcare.

Here, the authors discuss the steps of this process and how it’s guiding Aspect Health’s latest project.

Step 1: Gathering input for research-informed healthcare development

From July through October 2021, Aspect Health and the Gensler Research Institute (GRI) conducted an in-depth survey of 1,438 randomly selected patients from nine orthopedic outpatient care facilities located in the Northeast. The process would inform the design of a new specialty facility in the region.

Orthopedic practices were identified as model users of healthcare facilities that are often separated from hospital campuses, provide specialized care, and benefit from having an ambulatory surgery center as a co-user of the facility.

The goal was to measure the experiences of stakeholders—outpatients, care providers, and healthcare team members—in the delivery of care and the design of facilities. Outpatients provided input about their last visit to one of these facilities. Additionally, 75 care team members (more than 50 percent of the care team members) provided input about their own experiences and workflow efficiencies in these facilities.

The study had five goals:

  1. Objectively measure the impact of design on the outpatient and care team member experiences
  2. Measure the impact of digital solutions on the outpatient and care team member experience
  3. Integrate development, strategy, design, and management of a facility with shared information and decision making among diverse groups of care team members and other key stakeholders
  4. Establish a pre- and post-occupancy process so the research team could provide continuous insights for developments and innovation over a facility’s life cycle
  5. Apply findings to development and design decision-making for future orthopedic centers of excellence and ambulatory surgery centers.

The outpatient research conducted by GRI indicated that key drivers of outpatient loyalty, which is a measure of patients’ spending intentions, perceived value of healthcare service, likelihood to recommend, and likelihood of returning.

The top drivers included a strong first impression upon arrival, pre-visit interactions with staff, inviting and efficient exam room design that allows patient’s participation in the dialogue with physicians, and a brand that was distinctive from nearby alternatives. Upward of 62 percent of outpatient loyalty was driven by these factors.

Other important considerations are  intuitive wayfinding, waiting areas that provide a range of seating to support orthopedic patients’ physical challenges, and natural light. According to the research outpatient loyalty.

The separate care team survey included a diverse selection of staff, including nurses, physicians, surgeons, physical therapists, and administrative staff. For these respondents, design, operational, and technology considerations were key drivers for higher motivation, engagement, and effective interactions with outpatients.

Other drivers of successful care team member experiences include job reliance on outpatient care and coordination, work with colleagues in a collaborative environment, work with external partners, telemedicine, access to restorative settings, adherence to safety protocols, and space and workflow efficiencies.

Step 2: Translating research into outpatient facility design

The next step was to translate the research insights into the design. The ultimate goal was to advance a strategy that Aspect Health, as the developer, in collaboration with both the designers and the healthcare operating system, could apply to a new state-of-the-art orthopedic center of excellence and ambulatory surgery center in Rockland County, N.Y. The project is anticipated to be completed in fall 2023.

The research identified significant design parameters, each of which are illustrated within the final design through building materials, scale, and context to the location.

Among the design strategies are:

  • Exterior features offer a welcoming experience that inspires professionalism starting with accessible parking areas, a curated arrival experience with an oversized canopy, and vestibule area for seamless patient drop-off. Transparency of the building exterior will allow patients to orient themselves upon entry.
  • Outside, green space is expressive of nature and diverse physical activities representative of a range of individual orthopedic abilities.
  • Entry and an activated lobby are key touchpoints that offer a shift from a traditional concierge desk thanks to intuitive wayfinding. The lobby instead offers lounge space and a coffee bar. In the lobby illuminated textile screens will display abstract artwork that represents the movement of athletic figures to inspire people with challenging mobility.
  • Waiting areas include abundant natural light and views of greenery outdoors.
  • Furniture selections and groupings should allow patients and caretakers to have a choice of seating while supporting physical challenges. Design incorporates patterns found in nature, using organic and gradient patterns in wallcoverings and fabrics throughout. This carries through to wayfinding, clear circulation, and use of materials throughout the facility which are sympathetic to the surroundings and scale of the local community.
  • Exam rooms encourage participation with patients’ and their accompanying family members to participate. All rooms feature frosted glass barn-doors that allow light to filter through.
  • Physical therapy space located on the second floor in the northeast corner of the building feature natural light and views to the outdoors. These elements are proven to help patients in their healing process.
  • Technology use before, during, and after a visit create efficiency of operations and interactions through digital technology within the facility. Personal smart devices engage with providers to create positive experiences among patients, doctors, and caretakers.
  • Dedicated care team work area and amenities, including a dedicated pod for every six exam rooms, allow focused patient care and efficient flow. Each station features a sit-stand desk to support ergonomic needs and an area for group discussions. These spaces include a private phone room with dual functioning for telemedicine visits.
  • Four staff lounges are provided for each department to support the well-being of the physicians and their teams. Additionally, multipurpose space and wellness rooms are provided on each floor to support collaborative culture and a diversity of staff needs.

While the drivers, outcomes, and takeaways identified in this research can seem intuitive, the translation of these results into a functional and cost-effective design is an incredibly nuanced process. This began with detailed input from the end-user about services to be provided, and the anticipated staff expectations, aligned with the projected patient profile. The research was then analyzed within the context of identified needs and desires.

The need for strategic healthcare real estate development

The delivery of healthcare services has changed significantly in recent years. Health Systems are under enormous pressure to retain existing patients, attract new patients, and deliver quality service in an economical manner. Further, challenges related to staff retention and recruitment are immense.

The key to all of these issues is real estate, including the renovation of current facilities and the site sourcing and development of new facilities. Many existing healthcare facilities are inadequate and new facilities must be developed with a new strategic approach.

The traditional real estate approach of “build it and they will come” no longer works. Research-informed design is an invaluable benchmarking resource to monitor impact, design opportunities, and innovations on real estate development. Upon the completion of its current project as well as future projects, Aspect Health plans to continue further research and incorporate design lessons learned from each project.


Chris Smith is CEO at Aspect Health. He can be reached at csmith@AspectHealthRE.com. James Crispino is healthcare leader, principal at Gensler. He can be reached at James_Crispino@gensler.com. Nicholas Watkins, PhD, is global health sector research lead at Gensler Research Institute. He can be reached at nick_watkins@gensler.com.